Baby's first year - Month 4

By four months your baby may be better at sleeping but if not we have some settling tips below. It is also time for the next set of immunisations, and a general health check up. If baby is suffering from nappy rash, which many will at some point we have information below on how to treat it.

DEVELOPMENT

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SightA newborn baby can see just what she needs to see - people and objects at a distance of 18 to 35 centimetres. Baby can focus on an object in front of her face. Things that are further away are a blur though baby will 'look' at a bright light. Bright colours are more visible than pale colours.

It is perfectly normal for a baby's eye to appear to be crossed from time to time, but if the eyes seem to be permanently crossed then they need to be checked urgently. Eye colour can change up to the age of about six months.

By the age of four months, baby will be reaching for objects. Baby will also be able to follow a moving object with her eyes and look around - baby's world is a very fascinating place and she wants to see as much as she can. She will smile at those people she sees frequently.

Some people worry about flash lights affecting a baby's eyes. If this concerns you then try to take your photos in strong natural light or use a fast film, if you are using a film camera.Optometrists recommend that a baby should have her first eye examination at six months.

Find out more:To learn about how a baby's eyesight develops from birth to 12 months, read Your Baby's Eyes - a fact sheet from Child and Youth Health, SA Health.

Reactions to immunisationsImmunisation schedules change every few years and are not the same in every state. The National Health and Medical Research Foundation changed the schedule again in 2000 to reduce the number of injections given at each immunisation session.

Any injection can cause soreness, redness, swelling or burning at the point where the needle entered and itching which can last for one or two days. These symptoms can be relieved with a cold, wet cloth. A small hard lump may appear at the site and may take up to a couple of weeks to go down, but this is no cause for concern.

Very rare reactions are a temperature greater than 40° C, convulsions or collapse. If your baby's temperature goes up give him extra fluids (breast milk or infant formula), keep him cool and if his temperature goes over 38° C then give him paracetamol according to the directions on the packet. Take baby to your doctor or hospital clinic if you are at all worried.

ReminderYour baby can be immunised by your doctor, an immunisation clinic, your local council, your community child health nurse or possibly at a hospital.

If you haven't received a reminder (or maybe you have mislaid it!) this is the month your baby needs the next lot of immunisations. Use this Immunisation Calculator to help determine what immunisations are due. Don't forget to take your child's Personal Health Record when you go.

CARE:

Nappy rashDisposables are the nappy of choice in most Australian homes today, but despite what you may hear, disposables are not less likely to cause nappy rash than their old-fashioned cloth counterparts.The common cause of nappy rash is bacteria in baby's faeces, on her skin or in her clothing. This bacteria makes ammonia when it comes in contact with urine. Thrush can also aggravate a rash problem as can rough nappies and plastic pants.

Once baby develops nappy rash it can be difficult to get rid of, especially in cold weather when it is more difficult to give baby nappy-free time, than it is on warm, sunny days.

If you do use cloth nappies, it is very important to rinse them out well and make sure there is no soap left in them. Add half cup of pure soap flakes and six drops of tea tree oil to a bucket of hot water and then soak the nappies in it. Then wash the nappies in cold water and ¼ cup of soap flakes. The antiseptic tea tree oil sanitises the nappies.

To avoid or treat nappy rash:

Clean baby's skin carefully every time you change a nappy. Use a washer and warm water or baby wipes (not other wipes as they may contain alcohol which stings sore skin). Or use sorbolene cream.

Keep baby's skin as dry as possible - dry skin before you apply cream and change nappies as soon as you realise they are wet or dirty.

Let baby have nappy-free time every day.

Avoid plastic pants as much as possible.

Rinse nappies thoroughly and dry in a drier rather than in the sun which can make the nappy harsh.

Use barrier creams and ointments, such as zinc and castor oil cream or zinc and cod liver oil.

Settling techniquesIf you are struggling to get your baby to sleep and feel as though you will never get a good rest yourself, be comforted by the fact that there are many other parents who feel the same way. Here are some settling techniques to help your baby go to sleep (other than the 'cry-it-out' methods that first became popular in the 1820s!).

You may need to try a few different combinations before you find what works for your baby - there is no magic answer.

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Holding and soothing. Baby is crying because he has a need which can often just be that he needs comforting.

Calming with a massage or a warm bath.

Rocking - a rocking chair is perfect for this.

Patting. A gentle pat or rub of baby's bottom or back can work wonders.

A soothing CD of lullabies (preferable to a musical toy which can drive you crazy).

An extra feed.

A clock that ticks loudly.

A recording of moving water.

A warm room - ideal temperature is between 18 and 20Â° centigrade.

Singing softly.

Darkening the room.

Reading softly. It doesn't have to be a child's book every time, it can be your own book or magazine.

Find out more:The No-Cry Sleep Solution by Elizabeth Pantley also features a number of great settling techniques that do not rely on the 'cry-it-out' method.

Sleep guideThere is no set amount of time that a four month old baby will sleep. Some will sleep for 12 hours or more at night and have one or two long naps a day. Others will break it up more and have an eight hour sleep at night and shorter day naps - and others will only be sleeping for four or five hours day and night. Every baby sleeps according to his own needs. You need to be associating night time with sleep time by playing with her during the day when she is awake, but using settling techniques at night.

These guides are written for Essential Baby by child care author, Carol Fallows. Carol established Australian Parents magazine in the early 1980s as Australia's first parenting magazine and managed it for nearly 18 years. She continues to write about and for parents. Her most recent title is Having a Baby. The essential Australian guide to pregnancy and birth. (Transworld/Random House, 2005).

This information is not a substitute for professional advice. If you have any concerns about your child's health or wellbeing it is important that you seek help from your doctor or a health professional.